Provider Demographics
NPI:1891951653
Name:ALLIANCE CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ALLIANCE CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:907-696-1654
Mailing Address - Street 1:PO BOX 212255
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-2255
Mailing Address - Country:US
Mailing Address - Phone:907-337-6770
Mailing Address - Fax:907-338-6031
Practice Address - Street 1:4316 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4445
Practice Address - Country:US
Practice Address - Phone:907-337-6770
Practice Address - Fax:907-338-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK918089261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558434423OtherPROVIDER NPI
1720291149OtherPROVIDER NPI